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  • 1.
    Bernhardsson, Susanne
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Larsson, Maria E. H.
    Regional Vastra Gotaland, Sweden Gothenburg University, Sweden .
    Determinants of Guideline Use in Primary Care Physical Therapy: A Cross-Sectional Survey of Attitudes, Knowledge, and Behavior2014Inngår i: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 94, nr 3, s. 343-354Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background. Understanding of attitudes, knowledge, and behavior related to evidence-based practice (ESP) and use of evidence-based clinical practice guidelines in primary care physical therapy is limited. Objectives. The objectives of this study were: (1) to investigate self-reported attitudes, knowledge, behavior, prerequisites, and barriers related to EBP and guideline use among physical therapists in primary care and (2) to explore associations of self-reported use of guidelines with these social cognitive factors along with demographic and workplace characteristics. Design. This was a cross-sectional survey. Methods. A web-based survey of 419 physical therapists in primary care in western Sweden was performed. Multiple logistic regression analysis was performed to examine factors associated with guideline use. Results. The response rate was 64.7%. Most respondents had positive attitudes toward EBP and guidelines: 90% considered EBP necessary, and 96% considered guidelines important. Approximately two thirds reported confidence in finding and using evidence. One third reported being aware of guidelines. Thirteen percent knew where to find guidelines, and only 9% reported having easy access to guidelines. Fewer than half reported using guidelines frequently. The most important barriers to using guidelines were lack of time, poor availability, and limited access to guidelines. Young age and brief work experience were associated with positive attitudes toward EBP. A postgraduate degree was associated with higher application of EBP. Positive attitudes, awareness of guidelines, considering guidelines to facilitate practice, and knowing how to integrate patient preferences with guideline use were associated with frequent use of guidelines. Limitations. Data were self-reported, which may have increased the risk of social.desirability bias. Conclusions. Use of guidelines was not as frequent as could be expected in view of the positive attitudes toward EBP and guidelines among physical therapists. Awareness of and perceived access to guidelines were limited. The identified determinants can be addressed when developing guideline implementation strategies.

  • 2.
    Bernhardsson, Susanne
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Larsson, Maria E. H.
    Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden / The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    “In the physio we trust”: A qualitative study on patients’ preferences for physiotherapy2017Inngår i: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 33, nr 7, s. 535-549Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Patient preferences are suggested to be incorporated in clinical decision making, but little is known about preferences for physiotherapy treatment of patients with musculoskeletal pain. This study aimed to explore preferences regarding physiotherapy treatment and participation in decision making, of patients who seek primary care physiotherapy for pain in the back, neck or shoulder.

    Methods: A qualitative study set in an urban physiotherapy clinic in Sweden. Individual, semi-structured interviews were conducted with a purposeful sample of 20 individuals who sought physiotherapy for back, neck or shoulder pain. The interviews were digitally recorded, transcribed verbatim and analysed with qualitative content analysis.

    Results: An overarching theme, embracing six categories, was conceptualised: Trust in the physiotherapist fosters active engagement in therapy. Most informants preferred active treatment strategies such as exercise and advice for self-management, allowing them to actively engage in their therapy. Some preferred passive treatments, primarily acupuncture (because they had heard that it works well) or massage therapy (because “it feels good”). Preferences were consistent across the three musculoskeletal conditions. Key influencers on treatment preferences were previous experiences and media. All informants wanted to be involved in the clinical decision making, but to varying extents. Some expressed a preference for an active role and wanting to share decisions while others were content with a passive role. Expectations for a professional management were reflected in trust and confidence in physiotherapists’ skills and competence, expectations for good outcomes, and believing that treatment methods should be evidence-based.

    Conclusions: Trust in the physiotherapist’s ability to choose appropriate treatment and confidence in the professional skills and competence of physiotherapists, as well as a desire to participate in clinical decision making, fostered active engagement in physiotherapy. Preferences for particular interventions were subordinate, although a preference for active treatments dominated. Preferences for active engagement need to be embraced by the physiotherapist. Awareness of these preferences can facilitate clinical decision making and contribute to increased quality of care for patients with musculoskeletal pain.

  • 3.
    Bernhardsson, Susanne
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet. Region Västra Götaland.
    Larsson, Maria
    Region Västra Götaland, Göteborgs universitet.
    Eggertsen, Robert
    Region Västra Götaland, Göteborgs universitet.
    Fagevik Olsén, Monika
    Göteborgs universitet.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Nordeman, Lena
    Region Västra Götaland.
    van Tulder, Maurits
    VU University, Amsterdam, The Netherlands.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Evaluation of a tailored, multi-component intervention for implementation of evidence-based clinical practice guidelines in primary care physical therapy: a non-randomized controlled trial.2014Inngår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, nr 1, s. 105-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND:

    Clinical practice guidelines are important for transmitting research findings into practice and facilitating the application of evidence-based practice (EBP). There is a paucity of knowledge about the impact of guideline implementation strategies in primary care physical therapy. The aim of this study was to evaluate the effect of a guideline implementation intervention in primary care physical therapy in western Sweden.

    METHODS:

    An implementation strategy based on theory and current evidence was developed. A tailored, multi-component implementation intervention, addressing earlier identified determinants, was carried out in three areas comprising 28 physical therapy practices including 277 physical therapists (PTs) (intervention group). In two adjacent areas, 171 PTs at 32 practices received no intervention (control group). The core component of the intervention was an implementation seminar with group discussions. Among other components were a website and email reminders. Data were collected at baseline and follow-up with a web-based questionnaire. Primary outcomes were the self-reported awareness of, knowledge of, access to, and use of guidelines. Secondary outcomes were self-reported attitudes toward EBP and guidelines. Analyses were performed using Pearson's χ2 test and approximative z-test.

    RESULTS:

    168 PTs (60.6%) in the intervention group and 88 PTs (51.5%) in the control group responded to the follow-up questionnaire. 186/277 PTs (67.1%) participated in the implementation seminars, of which 97 (52.2%) responded. The proportions of PTs reporting awareness of (absolute difference in change 20.6%, p = 0.023), knowledge where to find (20.4%, p = 0.007), access to (21.7%, p < 0.001), and frequent use of (9.5%, NS) guidelines increased more in the intervention group than in the control group. The proportion of PTs reporting frequent guideline use after participation in the implementation seminar was 15.2% (p = 0.043) higher than the proportion in the control group. A higher proportion considered EBP helpful in decision making (p = 0.018). There were no other significant differences in secondary outcomes.

    CONCLUSIONS:

    A tailored, theory- and evidence-informed, multi-component intervention for the implementation of clinical practice guidelines had a modest, positive effect on awareness of, knowledge of, access to, and use of guidelines, among PTs in primary care in western Sweden. In general, attitudes to EBP and guidelines were not affected.

  • 4.
    Bernhardsson, Susanne
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Närhälsan Rehabilitation, Region Västra Götaland, Hönö, Sweden.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Larsson, Maria E. H.
    Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden; The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Clinical practice in line with evidence?: A survey among primary care physiotherapists in western Sweden2015Inngår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 21, nr 6, s. 1169-1177Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Rationale, aims and objectives

    Evidence-based practice is becoming increasingly important in primary care physiotherapy. Clinical practice needs to reflect current best evidence and be concordant with evidence-based clinical guidelines. There is limited knowledge about therapeutic interventions used in primary care physiotherapy in Sweden. The objectives were to examine preferred treatment interventions reported by publicly employed physiotherapists in primary care for three common musculoskeletal disorders (low back pain, neck pain and subacromial pain), the extent to which these interventions were supported by evidence, and associations with demographic variables.

    Methods

    419 physiotherapists in primary care in western Sweden were surveyed using a validated web-based questionnaire.

    Results

    The survey was completed by 271 respondents (65%). Median number of interventions reported was 7 (range 1–16). The most common treatment interventions across the three conditions were advice on posture (reported by 82–94%), advice to stay active (86–92%), and different types of exercise (65–92%). Most of these interventions were supported by evidence. However, interventions with insufficient evidence, such as advice on posture, TENS and aquatic exercise, were also used by 29–96%. Modalities such as laser therapy and ultrasound were sparingly used (<5%), which is in line with evidence. For neck pain, use of evidence-based interventions was associated with gender and for subacromial pain, with work experience.

    Conclusions

    Advice and exercise therapy were the interventions most frequently reported across the three diagnoses, illustrating an active treatment strategy. While most reported interventions are supported by evidence, interventions with unclear or no evidence of effect were also used to a high extent.

  • 5.
    Björnsson Hallgren, Hanna
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi. Linköpings universitet, Hälsouniversitetet.
    Holmgren, Theresa
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Adolfsson, Lars
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    A specific exercise strategy for patients with subacromial pain significantly reduced the need for surgery: one-year results of a randomised controlled studyManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Background: A specific exercise strategy focusing on eccentric exercises, for treating sbacromial pain has in a previous study been found effective at three-month followup.

    The aim of the present study was to investigate if the positive short-term results were maintained after one year. A further aim was to examine if baseline clinical score, rotator cuff status and radiological findings influenced the choice of surgery.

    Methods: 97 patients on the waiting-list for arthroscopic subacromial decompression were in the first study randomized to a three-month specific exercise strategy or unspecific exercises (controls). Patients were examined with radiology, ultrasound and assessed with clinical scores: primary Constant-Murley score. After three months of exercises the patients were asked if they still wanted surgery and this option was available until the one-year follow-up. All patients were re-assessed with clinical scores one year after inclusion or one year after surgical intervention and the number of patients that had chosen surgery in each group was compared. The baseline Constant-Murley score and the status of subacromial structures were analyzed in relation to patient's choice of surgery.

    Results: The positive short-term effect (improved shoulder function and pain) of the specific exercises was maintained after one-year. Compared to the three-month followup all patients had improved significantly (p < 0.0001) in Constant-Murley score. The number of patients that had chosen surgery in the control exercise group (63%) was significantly larger (p < 0.0001) than in the specific exercise group (24%). Patients that had chosen surgery had a significantly lower baseline Constant-Murley score and significantly more often a full-thickness tear. Patients with partial-thickness tears did not differ from those with intact cuff tendons.

    Conclusions: The positive short-term outcomes after specific exercises were maintained after one year and reduced the need of surgery significantly more than the unspecific control exercises. Patients with low baseline clinical score and/or a full-thickness tear significantly more often chose surgery.

    Level of evidence: I, Randomized controlled trail according to Consort statement.

  • 6.
    Björnsson Hallgren, Hanna
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för inflammationsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Holmgren, Theresa
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Adolfsson, Lars
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    A specific exercise strategy reduced the need for surgery in subacromial pain patients2014Inngår i: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 48, nr 19, s. 1431-1436Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and purpose A programme based on eccentric exercises for treating subacromial pain was in a previous study found effective at 3-month follow-up. The purposes of the present study were to investigate whether the results were maintained after 1 year and whether the baseline Constant-Murley score, rotator cuff status and radiological findings influenced the outcome. Patients and methods 97 patients on the waiting list for arthroscopic subacromial decompression had been randomised to a specific exercise programme or unspecific exercises (controls). After 3 months of exercises, the patients were asked whether they still wanted surgery and this option was available until a 1-year follow-up. 1 year after inclusion or 1 year after surgery, the number of patients who decided to have surgery in each group was compared. The choice of surgery was related to the baseline Constant-Murley score, ultrasound and radiographs taken at inclusion. Results All patients had improved significantly (pless than0.0001) in the Constant-Murley score at the 1-year follow-up. Significantly more patients in the control group decided to have surgery (63%) than those in the specific exercise group (24%; pless than0.0001). Patients who decided to have surgery had a significantly lower baseline Constant-Murley score and more often a full-thickness tear. Patients with partial tears did not differ from those with intact tendons. Interpretation The positive short-term results of specific exercises were maintained after 1 year, and this exercise strategy reduces the need for surgery. Full-thickness tear and a low baseline Constant-Murley score appear to be a predictive marker for a less good outcome.

  • 7.
    Björnsson, Hanna
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi. Linköpings universitet, Hälsouniversitetet.
    Norlin, Rolf
    Orebro University Hospital.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Adolfsson, Lars
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi och idrottsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    The influence of age, delay of repair, and tendon involvement in acute rotator cuff tears Structural and clinical outcomes after repair of 42 shoulders2011Inngår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 82, nr 2, s. 187-192Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and purpose Few authors have considered the outcome after acute traumatic rotator cuff tears in previously asymptomatic patients. We investigated whether delay of surgery, age at repair, and the number of cuff tendons involved affect the structural and clinical outcome. Patients and methods 42 patients with pseudoparalysis after trauma and no previous history of shoulder symptoms were included. A full-thickness tear in at least 1 of the rotator cuff tendons was diagnosed in all patients. Mean time to surgery was 38 (6-91) days. Follow-up at a mean of 39 (12-108) months after surgery included ultrasound, plain radiographs, Constant-Murley score, DASH score, and western Ontario rotator cuff (WORC) score. Results At follow-up, 4 patients had a full-thickness tear and 9 had a partial-thickness tear in the repaired shoulder. No correlation between the structural or clinical outcome and the time to repair within 3 months was found. The patients with a tendon defect at follow-up had a statistically significantly lower Constant-Murley score and WORC index in the injured shoulder and were significantly older than those with intact tendons. The outcomes were similar irrespective of the number of tendons repaired. Interpretation A delay of 3 months to repair had no effect on outcome. The patients with cuff defects at follow-up were older and they had a worse clinical outcome. Multi-tendon injury did not generate worse outcomes than single-tendon tears at follow-up.

  • 8.
    Carlfjord, Siw
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Nilsing-Strid, Emma
    University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Holmgren, Theresa
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Practitioner experiences from the structured implementation of evidence-based practice in primary care physiotherapy: A qualitative study2019Inngår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 25, nr 4, s. 622-629Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Rationale, Aims, and Objectives

    To provide best available care, the practitioners in primary health care (PHC) must have adequate knowledge about effective interventions. The implementation of such interventions is challenging. A structured implementation strategy developed by researchers at Linköping University, Sweden, was used for the implementation of an evidence‐based assessment and treatment programme for patients with subacromial pain among physiotherapists in PHC. To further develop strategies for implementation of evidence‐based practices, it was deemed important to study the implementation from the practitioners' perspective. The aim of this study was to explore the practitioners' experiences from the implementation.

    Methods

    A qualitative design with focus group discussions was applied. The implementation in terms of perceptions of process and outcome was evaluated by focus group discussions with, in total, 16 physiotherapists in the target group. Data were analysed using the method qualitative content analysis.

    Results

    The components of the strategy were viewed positively, and the applicability and evidence base behind the programme were appreciated. The programme was perceived to be adopted, and the practitioners described a changed behaviour and increased confidence in handling patients with subacromial pain. Both patient‐ and provider‐related challenges to the implementation were mentioned.

    Conclusions

    The practitioners' experiences from the implementation were mainly positive. A strategy with collaboration between academy and practice, and with education and implementation teams as facilitators, resulted in changes in practice. Critical voices concerned interprofessional collaboration and that the programme was focused explicitly on the shoulder, not including other components of physical function.

  • 9.
    Holmgren, Theresa
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Björnsson Hallgren, Hanna
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Adolfsson, Lars
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi och idrottsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study2012Inngår i: BMJ. British Medical Journal (International Ed.), ISSN 0959-8146, E-ISSN 0959-535X, Vol. 344, s. e787-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To evaluate if a specific exercise strategy, targeting the rotator cuff and scapula stabilisers, improves shoulder function and pain more than unspecific exercises in patients with subacromial impingement syndrome, thereby decreasing the need for arthroscopic subacromial decompression.

    DESIGN: Randomised, participant and single assessor blinded, controlled study.

    SETTING: Department of orthopaedics in a Swedish university hospital.

    PARTICIPANTS: 102 patients with long standing (over six months) persistent subacromial impingement syndrome in whom earlier conservative treatment had failed, recruited through orthopaedic specialists.

    INTERVENTIONS: The specific exercise strategy consisted of strengthening eccentric exercises for the rotator cuff and concentric/eccentric exercises for the scapula stabilisers in combination with manual mobilisation. The control exercise programme consisted of unspecific movement exercises for the neck and shoulder. Patients in both groups received five to six individual guided treatment sessions during 12 weeks. In between these supervised sessions the participants performed home exercises once or twice a day for 12 weeks.

    MAIN OUTCOME MEASURES: The primary outcome was the Constant-Murley shoulder assessment score evaluating shoulder function and pain. Secondary outcomes were patients' global impression of change because of treatment and decision regarding surgery.

    RESULTS: Most (97, 95%) participants completed the 12 week study. There was a significantly greater improvement in the Constant-Murley score in the specific exercise group than in the control exercise group (24 points (95% confidence interval 19 to 28.0) v 9 points (5 to 13); mean difference between group: 15 points (8.5 to 20.6)). Significantly more patients in the specific exercise group reported successful outcome (defined as large improvement or recovered) in the patients' global assessment of change because of treatment: 69% (35/51) v 24% (11/46); odds ratio 7.6, 3.1 to 18.9; P<0.001. A significantly lower proportion of patients in the specific exercise group subsequently chose to undergo surgery: 20% (10/51) v 63% (29/46); odds ratio 7.7, 3.1 to 19.4; P<0.001).

    CONCLUSION: A specific exercise strategy, focusing on strengthening eccentric exercises for the rotator cuff and concentric/eccentric exercises for the scapula stabilisers, is effective in reducing pain and improving shoulder function in patients with persistent subacromial impingement syndrome. By extension, this exercise strategy reduces the need for arthroscopic subacromial decompression within the three month timeframe used in the study.

    TRIAL REGISTRATION: Clinical trials NCT01037673.

  • 10.
    Holmgren, Theresa
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Björnsson Hallgren, Hanna
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för inflammationsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Adolfsson, Lars
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Republished research: Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study2014Inngår i: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 48, nr 19, s. 1456-1457Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    STUDY QUESTION Can a specific exercise strategy improve shoulder function and pain in patients with subacromial impingement syndrome, thereby decreasing the need for arthroscopic subacromial decompression? SUMMARY ANSWER Compared with a control exercise group, patients in the specific exercise group had significantly greater improvements in shoulder function and pain and fewer patients needed surgery at the three month assessment. WHAT IS KNOWN AND WHAT THIS PAPER ADDS Different exercise programmes are used as first line treatment in patients with subacromial impingement syndrome, but conclusive evidence to support the efficacy for these programmes is lacking. This specific exercise strategy proved effective in improving shoulder function and pain in patients in whom earlier conservative treatment had failed.

  • 11.
    Holmgren, Theresa
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Björnsson Hallgren, Hanna
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för inflammationsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Adolfsson, Lars
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för inflammationsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Republished research: Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study2013Inngår i: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 47, nr 14, s. 908-908Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Study question

    Can a specific exercise strategy improve shoulder function and pain in patients with subacromial impingement syndrome, thereby decreasing the need for arthroscopic subacromial decompression?

    Summary answer

    Compared with a control exercise group, patients in the specific exercise group had significantly greater improvements in shoulder function and pain and fewer patients needed surgery at the three month assessment.

    What is known and what this paper adds

    Different exercise programmes are used as first line treatment in patients with subacromial impingement syndrome, but conclusive evidence to support the efficacy for these programmes is lacking. This specific exercise strategy proved effective in improving shoulder function and pain in patients in whom earlier conservative treatment had failed.

  • 12.
    Holmgren, Theresa
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Adolfsson, Lars
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Minimal important changes in the Constant Murley score in patients with subacromial pain2014Inngår i: Journal of shoulder and elbow surgery, ISSN 1058-2746, E-ISSN 1532-6500, Vol. 23, nr 8, s. 1083-1090Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The purpose of this study was to determine the minimal important change (MIC) of improvement in the Constant‐Murley score (CM score) in patients with longstanding subacromial pain and in subgroups of patients with subacromial pain with and without rotator cuff ruptures.

    Method: The MIC was estimated by using the visual anchor‐based MIC distribution method, which integrates an anchor‐ and distribution‐based approach: the optimal cut‐off point of the receiver operator characteristic curve (MIC ROC) and the 95% limit cut‐ off point (MIC 95%limit). The study population consisted of 93 patients included in a randomized clinical trial evaluating the effect of a specific exercise strategy in patients with longstanding subacromial pain.

    Results: The MIC ROC was found at a mean change of 17 points in the CM score. The MIC 95% limit was found at a mean change of 24 points. In the subgroup analysis the MIC ROC was found at a mean change of 19 points and the MIC 95% limit at 18 points in patients with an intact rotator cuff. In patients with rotator cuff ruptures the MIC ROC was found at a mean change of 15 points and the MIC 95% limit at 30 points.

    Conclusion: The CM score is able to detect the minimal important change in individual patients with long‐standing subacromial pain when the rotator cuff is intact. In all patients with longstanding subacromial pain, the MIC value was dependent on the subgroup as well as the choice of statistical analysis. The estimated MIC values could be used as an indication for relevant changes in the CM score in clinical practice and guide the clinician in how to interpret the results of specific treatments for patients with longstanding subacromial pain.

  • 13.
    Holmgren, Theresa
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Sjöberg, Irene
    Oskarshamn Primary Care.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Supervised strengthening exercises versus home-based movement exercises after arthroscopic acromioplasty: A randomized clinical trial2012Inngår i: Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine, ISSN 1651-2081, Vol. 44, nr 1, s. 12-18Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To evaluate and compare the efficacy of 2 rehabilitation strategies after arthroscopic acromioplasty: supervised physical therapy focusing on strengthening exercises of the rotator cuff and scapula stabilizers (PT-group) vs home-based movement exercises (H-group). Design: A randomized, single-blinded, clinically controlled study. Patients: Thirty-six patients entered the study. Thirteen in the PT-group and 16 in the H-group fulfilled all the assessments. Methods: For 12 weeks following surgery, patients performed either supervised physical therapy or home exercises. Follow-ups were conducted periodically for 6 months after surgery to evaluate shoulder function, pain (Constant-Murley (CM) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores), and health-related quality of life. Results: The PT-group exhibited significantly greater improvements in CM (p  =0.02) and DASH (p = 0.05) scores. After treatment, the between-group mean difference in CM scores was 14.2 p (95% confidence interval 2-26). At the 6-month follow-up, the between-group mean difference in DASH scores was 13.4 p (95% confidence interval 0.1-23). Conclusion: PT-supervised rehabilitation with strengthening exercises of the rotator cuff and scapula stabilizers seems to be superior to home exercises focusing on mobility for improving shoulder function after arthroscopic acromioplasty.

  • 14.
    Hultenheim Klintberg, Ingrid
    et al.
    Institution Neuroscience and Physiology/Physitherapy, University of Gothenburg and Physiotherapy Department Sahlgrenska University Hospital, Gothenburg, Sweden.
    Cools, Ann M J
    Department of Rehabilitation Sciences & Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgum.
    Holmgren, Theresa
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Holzhausen, Ann-Christine Gunnarsson
    Institution Neuroscience and Physiology/Physitherapy, University of Gothenburg and Physiotherapy Department Sahlgrenska University Hospital, Gothenburg, Sweden.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Maenhout, Annelies G
    Department of Rehabilitation Sciences & Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgum.
    Moser, Jane S
    Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals Trust, Oxford, UK.
    Spunton, Valentina
    University of Genoa, Genoa, Italy.
    Ginn, Karen
    Discipline of Biomedical Science, School of Medical Sciences, Sydney Medical School, The University of Sydney, Sydney, Australia.
    Consensus for physiotherapy for shoulder pain2015Inngår i: International Orthopaedics, ISSN 0341-2695, E-ISSN 1432-5195, Vol. 39, nr 4, s. 715-720Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: Shoulder pain is a common disorder. Despite growing evidence of the importance of physiotherapy, in particular active exercise therapy, little data is available to guide treatment. The aim of this project was to contribute to the development of an internationally accepted assessment and treatment algorithm for patients with shoulder pain.

    METHODS: Nine physiotherapists with expertise in the treatment of shoulder dysfunction met in Sweden 2012 to begin the process of developing a treatment algorithm. A questionnaire was completed prior to the meeting to guide discussions. Virtual conferences were thereafter the platform to reach consensus.

    RESULTS: Consensus was achieved on a clinical reasoning algorithm to guide the assessment and treatment for patients presenting with local shoulder pain, without significant passive range of motion deficits and no symptoms or signs of instability. The algorithm emphasises that physiotherapy treatment decisions should be based on physical assessment findings and not structural pathology, that active exercises should be the primary treatment approach, and that regular re-assessment is performed to ensure that all clinical features contributing to the presenting shoulder pain are addressed. Consensus was also achieved on a set of guiding principles for implementing exercise therapy for shoulder pain, namely, a limited number of exercises, performed with appropriate scapulo-humeral coordination and humeral head alignment, in a graduated manner without provoking the presenting shoulder pain.

    CONCLUSION: The assessment and treatment algorithm presented could contribute to a more formal, extensive process aimed at achieving international agreement on an algorithm to guide physiotherapy treatment for shoulder pain.

  • 15.
    Johansson, Kajsa
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Sjukgymnastik.
    Behandling i primärvård av patienter med subacromial smärta2006Inngår i: SgSS- Smärtkongress 2006,2006, 2006Konferansepaper (Annet vitenskapelig)
    Abstract [sv]

       

  • 16.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Corticosteroid injection or acupuncture combined with standardized home-exercises for patients with subacromial pain?2010Konferansepaper (Annet vitenskapelig)
  • 17.
    Johansson, Kajsa
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Sjukgymnastik.
    Diagnostik och behandling av patienter med subacromial smärta2006Inngår i: Akupunkturkongress 2006,2006, 2006Konferansepaper (Annet vitenskapelig)
    Abstract [sv]

       

  • 18.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    General Practitioners and Physiotherapists view on subacromial pain1998Konferansepaper (Annet vitenskapelig)
  • 19.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Hur kan klassificering, diagnosticering och subgruppering vid ryggbesvär och skulderbesvär användas i sjukgymnastens kliniska vardag?”2007Konferansepaper (Annet (populærvitenskap, debatt, mm))
  • 20.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Patients with subacromial pain: Diagnosis, treatment and outcome in primary care2004Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [sv]

    Syftet med avhandlingen var att beskriva diagnostiken och utvärdera handläggningen i primärvård av patienter med subacromial smärta.

    Avhandlingen omfattar fyra studier.

    I den första studien användes ett frågeformulär och resultaten beskriver hur distriktsläkare och distriktssjukgymnaster i ett svenskt län diagnosticerar och handlägger primärvårdspatienter med subacromial smärta.

    Den andra studien beskriver distriktsläkares och distriktssjukgymnasters tilltro till effekten av olika behandlingsmetoder för dessa patienter. Med utgångspunkt från de tilltrodda behandlingsmetoderna genomfördes en systematisk litteraturöversikt.

    Den tredje studien utvärderar intra- och interbedömar reliabilitet för ett styrketest som ingår i ett utvärderingsinstrument ‘the Constant-Murley shoulder assessment’.

    Den avslutande studien är en randomiserad klinisk studie som utvärderar och jämför effekten av två behandlingsstrategier, akupunktur och ultraljud, båda i kombination med hemträning.

    Distriktsläkare och distriktssjukgymnaster visade sig använda en likartad diagnostik. Det troligaste valet av behandling för distriktsläkare var antiinflammatoriska läkemedel och kortisoninjektion i den subacromiala bursan och för distriktssjukgymnaster rörelseträning samt ergonomiska åtgärder.

    Dock var de flesta behandlingsalternativen troliga val, vilket tolkas som en osäkerhet om behandlingarnas effekt.

    Med utgångspunkt från de behandlingsmetoder som distriktsläkare och distriktssjukgymnaster tilltrodde som effektiva för patienter med subacromial smärta, genomfördes en systematisk kritisk litteraturöversikt. Fyrtio studier inkluderades och deras evidensnivå utvärderades. Endast kortisoninjektion i den subacromiala bursan visade sig ha definitiva bevis för effekt. Akupunktur visade sig ha troliga bevis för effekt och ultraljudsbehandling konkluderades som ineffektivt för patienter med subacromial smärta. Det förelåg en låg grad av samstämmighet mellan tilltro och tillgängliga vetenskapliga bevis.

    En digital dynamometer kan ersätta den konventionella fjädervågen i det standardiserade styrketestet. En nästan perfekt överensstämmelse vad gäller både intra- och interbedömarreliabilitet vid test av unga skulderfriska personer, oberoende av om en ”håll emot-” eller ”dragteknik” användes eller om medel- eller maxvärden användes vid beräkningen av överensstämmelse.

    I den randomiserade kliniska studien inkluderades 85 patienter. Tre utvärderingsinstrument, kombinerade i resultatanalysen, utvärderade förändringen under en uppföljningsperiod på 12 månader tillsammans med patienternas subjektiva skattning av resultatet.

    Resultaten visade att akupunktur i kombination med hemträning är att föredra. Båda behandlingsgrupperna förbättrades signifikant och fortsatte förbättras över tid oberoende av behandling. De flesta patienter uppnådde ett tillfredställande behandlingsresultat efter 12 månader. Åtminstone tre fjärdedelar i varje behandlingsgrupp skattade sig mycket förbättrade eller helt återställda. Detta tolkas som en behandlingseffekt i kombination med naturalförloppet.

    Avhandlingen har beskrivit handläggningen i primärvård av patienter med subacromial smärta och har bidragit med vetenskapliga bevis för distriktsläkare att behandla med kortisoninjektion i subacromiala bursan och för distriktssjukgymnaster att behandla med akupunktur kombinerat med hemträning.

    Delarbeid
    1. Attitudes toward management of patients with subacromial pain in Swedish primary care
    Åpne denne publikasjonen i ny fane eller vindu >>Attitudes toward management of patients with subacromial pain in Swedish primary care
    1999 (engelsk)Inngår i: Family Practice, ISSN 0263-2136, Vol. 16, nr 3, s. 233-237Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Objective. We aimed to describe the attitudes among GPs and physiotherapists toward the diagnostic approach and management of patients with a common shoulder disorder.

    Method. A questionnaire was sent out to 188 GPs and 71 physiotherapists. The total response rate was 71.8%. The questions were based on a written case simulation with cues about history and symptoms.

    Results. The results showed a unanimous opinion of the diagnosis. Rotator cuff tendinitis was marked as the most probable. The two groups showed similarities in the way that they would examine the patient. The GPs referred the patients to the physiotherapists significantly more often than the other way around. The most probable choice of treatment made by the GPs was non-steroidal anti-inflammatory drugs (NSAIDs) and by the physiotherapists, movement exercises together with ergonomics. Most treatment alternatives had at least 20% of the responders marking a neutral attitude, and few treatments were disregarded.

    Conclusions. We conclude that in Swedish primary care GPs and physiotherapists have a uniform diagnostic approach towards patients with subacromial pain, but their choice of treatment reflects an uncertainty about the effectiveness of conservative treatments. The questioned pathogenesis of the suggested diagnosis and lack of research regarding the efficacy of conservative treatments could explain this uncertainty.

    Emneord
    Conservative treatment, general practice, questionnaire, shoulder problems, written case simulation
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-14390 (URN)
    Merknad
    Original Publication: Kajsa Johansson, Lars Adolfsson and Mats Foldevi, Attitudes toward management of patients with subacromial pain in Swedish primary care, 1999, Family Practice, (16), 3, 233-237. http://fampra.oxfordjournals.org/cgi/content/abstract/16/3/233 Copyright: Oxford University Press http://fampra.oxfordjournals.org/ Tilgjengelig fra: 2007-04-05 Laget: 2007-04-05 Sist oppdatert: 2009-11-22
    2. A combination of systematic review and clinicians’ beliefs in interventions for subacromial pain
    Åpne denne publikasjonen i ny fane eller vindu >>A combination of systematic review and clinicians’ beliefs in interventions for subacromial pain
    2002 (engelsk)Inngår i: British Journal of General Practice, ISSN 0960-1643, Vol. 52, nr 475, s. 145-152Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    The aim of the study is to determine which treatments for patients with subacromial pain are trusted by general practitioners (GPs) and physiotherapists, and to compare trusted treatments with evidence from a systematic critical review of the scientific literature. A two-step process was used: a questionnaire (written case simulation) and a systematic critical review. The questionnaire was mailed to 18 GPs and 71 physiotherapists in Sweden. The total response rate was 72% (186/259). The following treatments were trusted: ergonomics/adjustments at work, corticosteroids, non-steroidal anti-inflamatory drugs, movement exercises, acupuncture, ultrasound therapy, strengthening exercises, stretching, transcutaneous electric nerve stimulation, and superficial heat or ice therapy. The review, including efficacy studies for the treatments found to be trusted, was conducted using the CINAHL, EMBASE and MEDLINE databases. Evidence for efficacy was recorded in relation to methodological quality and to diagnostic criteria that labelled participants as having subacromial pain or a non-specific shoulder disorder. Forty studies were included. The methodological quality varied and only one treatment had definitive evidence for efficacy for non-specific patients, namely injection of corticosteroids. The trust in corticosteroids, injected in the subacromial bursa, was supported by definitive evidence for short-term efficacy. Acupuncture had tentative evidence for short-term efficacy in patients with subacromial pain. Ultrasound therapy was ineffective for subacromial pain. This is supported by tentative evidence and, together with earlier reviews, this questions both the trust in the treatment and its use. The clinicians' trust in treatments had a weak association with available scientific evidence.

    Emneord
    SUBACROMIAL, PAIN, PHYSIOTHERAPY, ROTATOR, CUFF, SHOULDER, SYSTEMATIC, REVIEW
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-14391 (URN)
    Tilgjengelig fra: 2007-04-05 Laget: 2007-04-05 Sist oppdatert: 2009-08-19
    3. Intraobserver and interobserver reliability for the strength test in the Constant-Murley shoulder assessment
    Åpne denne publikasjonen i ny fane eller vindu >>Intraobserver and interobserver reliability for the strength test in the Constant-Murley shoulder assessment
    2005 (engelsk)Inngår i: Journal of Shoulder and Elbow Surgery, ISSN 1058-2746, Vol. 14, nr 3, s. 273-278Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    This study evaluates the standardized strength test in the Constant-Murley shoulder assessment of adults with healthy shoulders in a randomized, single-blind design. The following questions were to be answered: (1) Can the spring balance and a digital dynamometer both yield the same result? (2) What is the intraobserver and interobserver reliability of the strength test? (3) Is the strength test sensitive to change in technique or affected by calculation with mean or maximum values? Ten subjects were included in a comparison of the Handyscale (digital dynamometer) and the mechanical spring balance for concurrent validity, resulting in intraclass correlation coefficient values ranging from 0.96 to 0.99. For intraobserver and interobserver reliability, 2 observers tested 20 subjects with the Handyscale and retested them after 2 weeks. Regardless of technique during testing, this resulted in almost perfect agreement (intraclass correlation coefficient range, 0.89–0.98). The digital dynamometer can replace the conventional spring balance. The standardized strength test in the Constant-Murley shoulder assessment is reliable in young subjects with healthy shoulders, independent of technique or whether calculated with mean or maximum values.

    Emneord
    Constant-Murley shoulder asssessment
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-14392 (URN)10.1016/j.jse.2004.08.001 (DOI)
    Merknad
    Original Publication: Kajsa Johansson and Lars Adolfsson, Intraobserver and interobserver reliability for the strength test in the Constant-Murley shoulder assessment, 2005, Journal of Shoulder and Elbow Surgery, (14), 3, 273-278. http://dx.doi.org/10.1016/j.jse.2004.08.001 Copyright: Elsevier Science B.V., Amsterdam http://www.elsevier.com/ Tilgjengelig fra: 2007-04-05 Laget: 2007-04-05 Sist oppdatert: 2009-11-22
    4. Effects of acupuncture versus ultrasound for patients with impingement syndrome: Randomized clinical trial
    Åpne denne publikasjonen i ny fane eller vindu >>Effects of acupuncture versus ultrasound for patients with impingement syndrome: Randomized clinical trial
    2005 (engelsk)Inngår i: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 85, nr 6, s. 490-501Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Background and Purpose. There is no definitive evidence for the efficacy of the physical therapy interventions used for patients with impingement syndrome. The purpose of this study was to compare manual acupuncture and continuous ultrasound, both applied in addition to home exercises, for patients diagnosed with impingement syndrome.

    Subjects and Methods. Eighty-five patients with clinical signs of impingement syndrome were randomly assigned to either a group that received acupuncture (n=44) or a group that received ultrasound (n=41). Both interventions were given by physical therapists twice a week for 5 weeks in addition to a home exercise program. Scores from 3 shoulder disability measures, combined in the analysis, measured change during a period of 12 months.

    Results. Both groups improved, but the acupuncture group had a larger improvement in the combined score.

    Discussion and Conclusion. The results suggest that acupuncture is more efficacious than ultrasound when applied in addition to home exercises.

    Emneord
    Family practice, Home exercise program, Physical therapy, Rotator cuff, Subacromial pain
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-14393 (URN)
    Merknad
    Original Publication: Kajsa Johansson, Lars Adolfsson and Mats Foldevi, Effects of acupuncture versus ultrasound for patients with impingement syndrome: Randomized clinical trial, 2005, Physical Therapy, (85), 6, 490-501. http://ptjournal.apta.org/cgi/reprint/85/6/490 Copyright2005 Apta American Physical Therapy Association http://www.apta.org/ Tilgjengelig fra: 2007-04-05 Laget: 2007-04-05 Sist oppdatert: 2017-12-13
  • 21.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Should the physiotherapist treat the subacromial impingement patient with acupuncture or ultrasound?1999Konferansepaper (Annet vitenskapelig)
  • 22.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Subacromial impingement syndrome a randomised clinical trial subacromial corticosteroid injection vs. home-exercises combined with acupuncture2008Konferansepaper (Annet vitenskapelig)
  • 23.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Subacromial pain – is trust in treatment supported by evidence?2000Konferansepaper (Annet vitenskapelig)
  • 24.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Subacromial smärta2010Konferansepaper (Annet vitenskapelig)
  • 25.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Subacromial smärta2009Konferansepaper (Annet vitenskapelig)
  • 26.
    Johansson, Kajsa
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Adolfsson, Lars
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi och idrottsmedicin. Linköpings universitet, Hälsouniversitetet.
    Intraobserver and interobserver reliability for the strength test in the Constant-Murley shoulder assessment2005Inngår i: Journal of Shoulder and Elbow Surgery, ISSN 1058-2746, Vol. 14, nr 3, s. 273-278Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study evaluates the standardized strength test in the Constant-Murley shoulder assessment of adults with healthy shoulders in a randomized, single-blind design. The following questions were to be answered: (1) Can the spring balance and a digital dynamometer both yield the same result? (2) What is the intraobserver and interobserver reliability of the strength test? (3) Is the strength test sensitive to change in technique or affected by calculation with mean or maximum values? Ten subjects were included in a comparison of the Handyscale (digital dynamometer) and the mechanical spring balance for concurrent validity, resulting in intraclass correlation coefficient values ranging from 0.96 to 0.99. For intraobserver and interobserver reliability, 2 observers tested 20 subjects with the Handyscale and retested them after 2 weeks. Regardless of technique during testing, this resulted in almost perfect agreement (intraclass correlation coefficient range, 0.89–0.98). The digital dynamometer can replace the conventional spring balance. The standardized strength test in the Constant-Murley shoulder assessment is reliable in young subjects with healthy shoulders, independent of technique or whether calculated with mean or maximum values.

  • 27.
    Johansson, Kajsa
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Adolfsson, Lars
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi och idrottsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Ortopedicentrum, Ortopedkliniken Linköping.
    Foldevi, Mats
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Primärvård: Vårdcentraler, Rörelse & Hälsa, LAH, Ungdomsmottagningen .
    Attitudes toward management of patients with subacromial pain in Swedish primary care1999Inngår i: Family Practice, ISSN 0263-2136, Vol. 16, nr 3, s. 233-237Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. We aimed to describe the attitudes among GPs and physiotherapists toward the diagnostic approach and management of patients with a common shoulder disorder.

    Method. A questionnaire was sent out to 188 GPs and 71 physiotherapists. The total response rate was 71.8%. The questions were based on a written case simulation with cues about history and symptoms.

    Results. The results showed a unanimous opinion of the diagnosis. Rotator cuff tendinitis was marked as the most probable. The two groups showed similarities in the way that they would examine the patient. The GPs referred the patients to the physiotherapists significantly more often than the other way around. The most probable choice of treatment made by the GPs was non-steroidal anti-inflammatory drugs (NSAIDs) and by the physiotherapists, movement exercises together with ergonomics. Most treatment alternatives had at least 20% of the responders marking a neutral attitude, and few treatments were disregarded.

    Conclusions. We conclude that in Swedish primary care GPs and physiotherapists have a uniform diagnostic approach towards patients with subacromial pain, but their choice of treatment reflects an uncertainty about the effectiveness of conservative treatments. The questioned pathogenesis of the suggested diagnosis and lack of research regarding the efficacy of conservative treatments could explain this uncertainty.

  • 28.
    Johansson, Kajsa
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Adolfsson, Lars
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi och idrottsmedicin. Linköpings universitet, Hälsouniversitetet.
    Foldevi, Mats
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Effects of acupuncture versus ultrasound for patients with impingement syndrome: Randomized clinical trial2005Inngår i: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 85, nr 6, s. 490-501Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and Purpose. There is no definitive evidence for the efficacy of the physical therapy interventions used for patients with impingement syndrome. The purpose of this study was to compare manual acupuncture and continuous ultrasound, both applied in addition to home exercises, for patients diagnosed with impingement syndrome.

    Subjects and Methods. Eighty-five patients with clinical signs of impingement syndrome were randomly assigned to either a group that received acupuncture (n=44) or a group that received ultrasound (n=41). Both interventions were given by physical therapists twice a week for 5 weeks in addition to a home exercise program. Scores from 3 shoulder disability measures, combined in the analysis, measured change during a period of 12 months.

    Results. Both groups improved, but the acupuncture group had a larger improvement in the combined score.

    Discussion and Conclusion. The results suggest that acupuncture is more efficacious than ultrasound when applied in addition to home exercises.

  • 29.
    Johansson, Kajsa
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland.
    Adolfsson, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Ortopedi och Idrottsmedicin. Östergötlands Läns Landsting, Ortopedicentrum, Ortopedkliniken Linköping.
    Foldevi, Mats
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland.
    "Effects of Acupuncture Versus Ultrasound in Patients With Impingement Syndrome: A Randomized Clinical Trial" comment and author reply2006Inngår i: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 86, s. 143-145Artikkel i tidsskrift (Annet vitenskapelig)
  • 30.
    Johansson, Kajsa
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Bergström, Anna
    Östergötlands Läns Landsting.
    Schröder, Karin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Östergötlands Läns Landsting.
    Foldevi, Mats
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Vårdcentraler.
    Subacromial corticosteroid injection or acupuncture with home exercises when treating patients with subacromial impingement in primary care-a randomized clinical trial2011Inngår i: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 28, nr 4, s. 355-365Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    bjective. To compare the efficacy of subacromial corticosteroids injected by a GP with physiotherapy combining acupuncture and home exercises as treatments for SIS. less thanbrgreater than less thanbrgreater thanMethods. A randomized clinical trial was performed in primary health care. Patients diagnosed with SIS were randomized to either subacromial corticosteroid injection (s) or 10 acupuncture treatments combined with home- exercises. The main outcomes were pain and shoulder function (Adolfsson-Lysholm shoulder assessment score). Secondary outcomes were health-related quality of life (HRQL) (EuroQol-five dimension self-report questionnaire) and the patients global assessment of change. All patients were assessed at baseline and after 6 weeks and 3, 6 and 12 months. less thanbrgreater than less thanbrgreater thanResults. One hundred and seventeen patients with SIS were included, of which 91 complied with the study protocol. There were no significant differences between treatments with regard to pain, shoulder function and HRQL in change over time. However, both treatment groups improved significantly from baseline over time. less thanbrgreater than less thanbrgreater thanConclusions. Both subacromial corticosteroid injection and a series of acupuncture treatments combined with home exercises significantly decreased pain and improved shoulder function in patients with SIS, but neither treatment was significantly superior to the other.

  • 31.
    Johansson, Kajsa
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Ivarson , Sören
    Feelgood AB, Linköping.
    Intra- and interexaminer reliability of four manual shoulder maneuvers used to identify subacromial pain2009Inngår i: MANUAL THERAPY, ISSN 1356-689X , Vol. 14, nr 2, s. 231-239Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Shoulder pain is a diagnostic challenge and the physical clinical examination of the shoulder is crucial. It is important that the diagnostic tests used are valid as well as reliable. The objective of the study was to assess intra- and interexaminer reliability for four Manual Shoulder maneuvers; the Neer impingement sign, the Hawkins-Kennedy impingement test, the Patte maneuver, the Jobe supraspinatus test. These maneuvers are frequently used in clinical practice to examine patients with shoulder complaints in which subacromial pain is highly suspected. Thirty-three participants with shoulder pain were included consecutively. Within a week from inclusion, the four maneuvers were performed by a physiotherapist. The procedure was standardized in order to increase reproducibility. After a week, the maneuvers were performed again by the same physical therapist (test-retest) and by another physical therapist (test for interexaminer reliability). All four maneuvers have an almost perfect agreement (Kappa coefficients 0.91-1.00), if performed with suggested standardizations. Neer impingement sign, Hawkins-Kennedy impingement test, Patte maneuver as well as Jobe supraspinatus test, are highly reproducible and therefore reliable to use in clinical practice to identify patients with subacromial pain with an impingement phenomenon, but the maneuvers are limited as structural discriminators.

  • 32.
    Johansson, Kajsa
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Adolfsson, Lars
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi och idrottsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Ortopedicentrum, Ortopedkliniken Linköping.
    Foldevi, Mats
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Primärvård: Vårdcentraler, Rörelse & Hälsa, LAH, Ungdomsmottagningen .
    A combination of systematic review and clinicians’ beliefs in interventions for subacromial pain2002Inngår i: British Journal of General Practice, ISSN 0960-1643, Vol. 52, nr 475, s. 145-152Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of the study is to determine which treatments for patients with subacromial pain are trusted by general practitioners (GPs) and physiotherapists, and to compare trusted treatments with evidence from a systematic critical review of the scientific literature. A two-step process was used: a questionnaire (written case simulation) and a systematic critical review. The questionnaire was mailed to 18 GPs and 71 physiotherapists in Sweden. The total response rate was 72% (186/259). The following treatments were trusted: ergonomics/adjustments at work, corticosteroids, non-steroidal anti-inflamatory drugs, movement exercises, acupuncture, ultrasound therapy, strengthening exercises, stretching, transcutaneous electric nerve stimulation, and superficial heat or ice therapy. The review, including efficacy studies for the treatments found to be trusted, was conducted using the CINAHL, EMBASE and MEDLINE databases. Evidence for efficacy was recorded in relation to methodological quality and to diagnostic criteria that labelled participants as having subacromial pain or a non-specific shoulder disorder. Forty studies were included. The methodological quality varied and only one treatment had definitive evidence for efficacy for non-specific patients, namely injection of corticosteroids. The trust in corticosteroids, injected in the subacromial bursa, was supported by definitive evidence for short-term efficacy. Acupuncture had tentative evidence for short-term efficacy in patients with subacromial pain. Ultrasound therapy was ineffective for subacromial pain. This is supported by tentative evidence and, together with earlier reviews, this questions both the trust in the treatment and its use. The clinicians' trust in treatments had a weak association with available scientific evidence.

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